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Organization
THERAPEUTIC ASSISTED LIVING CORP.
Active
Organization
THERAPEUTIC ASSISTED LIVING CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATASHA D GILYARD (ALF ADMINISTRATOR)
(904) 501-8991
Entity
Organization
Contact information
Practice address
25 LYNDENHURST LN, PALM COAST, FL 32137-9521
(904) 501-8991
(844) 769-0772
Mailing address
25 LYNDENHURST LN, PALM COAST, FL 32137-9521
(904) 501-8991
(844) 769-0772
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
108468900
—
FL
Enumeration date
12/14/2020
Last updated
12/14/2020
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